Hypotensive  Resuscita0on  For    PROLONGED  EVACULATION  

 Time  is  the  Enemy  

 Kevin  Ward,  MD  

University  of  Michigan    

Why???  

Prevent  “Iatrogenic”  Exsanguina4on  Reduce  Coagulopathy  and  Organ  Failure  

Trade-­‐Off  

Sudden  Cardiovascular  Collapse  Irreversible  Shock  

Worsening  Organ  Failure  Worsening  of  TBI    

   

Makes  Me  Nervous  About  Hypotensive  Resuscita0on  (Prolonged)  

Big  Differences/Ques0ons  

•  Civilian  Urban  Trauma  Centers  •   Good  EMS  Systems:  Rapid  response  and  transport  

•  Damage  Control  Resuscita0on  •  Massive  Transfusion  Protocols  

•  Probably  Why  Hypertonic  Saline  Trial  Showed  No  Difference  

Field  Issues  Impact  on  Execu0on  •  Following  Mental  Status  –  TBI  vs.  Concussion  vs.  Analgesic  effects  – Need  Minimal  Coronary  and  Cerebral  Perfusion  Pressure  •  Once  under  it  very  difficult  if  not  impossible  to  recover  

•  For  pulse  character:  What  about  pain,  bradycardic  paradox  

•  Compressible  vs.  Noncompressible  Hemorrhage  –  Penetra0ng,  Blunt,  Blast  

•  Lung  Injury  and  Hypoxemia  •  Oxygen  Debt  Prior  to  Injury  (physical  ac0vity)  •  Even  with  In-­‐Field  Blood  or  Plasma  what  about  Blood  Pressure  Overshoot?  

Knowledge  and  Technology  GAPS  

What  Would  We  Need  for  a  Balanced  Approach  

•  New  Methods  of  Hemostasis  •  High  fidelity  Vital  Sign  Monitor  – Con0nuous  NIBP  

•  Metabolic  Monitoring  – StO2,  ,  Lactate,  HRV,  VO2  

•  Small  volume-­‐Blood-­‐Plasma  •  New  Metabolic  Therapies